Loma Linda University Children's Hospital

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$649,720.39

Service Code	MSDRG 003
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$649,720.39
Rate for Payer: Aetna of CA HMO/PPO	$649,720.39
Rate for Payer: EPIC Health Plan Commercial	$329,179.72
Rate for Payer: EPIC Health Plan Senior	$243,836.83
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$243,836.83
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$243,836.83
Rate for Payer: Molina Healthcare of CA Medicare	$326,741.35
Rate for Payer: Multiplan WC	$400,373.44
Rate for Payer: Prime Health Services WC	$396,288.00
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: ENDOCRINE DISORDERS WITH CC

Facility

$39,531.05

Service Code	MSDRG 644
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$39,531.05
Rate for Payer: Aetna of CA HMO/PPO	$31,328.55
Rate for Payer: EPIC Health Plan Commercial	$39,531.05
Rate for Payer: EPIC Health Plan Senior	$29,282.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$29,282.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$29,282.26
Rate for Payer: Molina Healthcare of CA Medicare	$39,238.23
Rate for Payer: Multiplan WC	$19,305.41
Rate for Payer: Prime Health Services WC	$19,108.42
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: ENDOCRINE DISORDERS WITH MCC

Facility

$50,242.71

Service Code	MSDRG 643
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$50,242.71
Rate for Payer: Aetna of CA HMO/PPO	$50,242.71
Rate for Payer: EPIC Health Plan Commercial	$48,390.26
Rate for Payer: EPIC Health Plan Senior	$35,844.64
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,844.64
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,844.64
Rate for Payer: Molina Healthcare of CA Medicare	$48,031.82
Rate for Payer: Multiplan WC	$30,960.78
Rate for Payer: Prime Health Services WC	$30,644.85
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$35,914.40

Service Code	MSDRG 645
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,914.40
Rate for Payer: Aetna of CA HMO/PPO	$23,607.07
Rate for Payer: EPIC Health Plan Commercial	$35,914.40
Rate for Payer: EPIC Health Plan Senior	$26,603.26
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,603.26
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,603.26
Rate for Payer: Molina Healthcare of CA Medicare	$35,648.37
Rate for Payer: Multiplan WC	$14,547.25
Rate for Payer: Prime Health Services WC	$14,398.81
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$216,703.00

Service Code	MSDRG 266
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$216,703.00
Rate for Payer: Aetna of CA HMO/PPO	$181,617.09
Rate for Payer: EPIC Health Plan Commercial	$109,924.72
Rate for Payer: EPIC Health Plan Senior	$81,425.72
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$81,425.72
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$81,425.72
Rate for Payer: Molina Healthcare of CA Medicare	$109,110.46
Rate for Payer: Multiplan WC	$111,916.85
Rate for Payer: Prime Health Services WC	$110,774.84
Rate for Payer: United Healthcare All Other Commercial	$216,703.00
Rate for Payer: United Healthcare All Other HMO	$204,544.00
Rate for Payer: United Healthcare HMO Rider	$155,367.00
Rate for Payer: United Healthcare Select/Navigate/Core	$142,342.00

MS-DRG 42.00: ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$162,712.00

Service Code	MSDRG 267
Min. Negotiated Rate	$25,651.00
Max. Negotiated Rate	$162,712.00
Rate for Payer: Aetna of CA HMO/PPO	$142,627.69
Rate for Payer: EPIC Health Plan Commercial	$91,662.49
Rate for Payer: EPIC Health Plan Senior	$67,898.14
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$67,898.14
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$67,898.14
Rate for Payer: Molina Healthcare of CA Medicare	$90,983.51
Rate for Payer: Multiplan WC	$87,890.63
Rate for Payer: Prime Health Services WC	$86,993.79
Rate for Payer: United Healthcare All Other Commercial	$162,712.00
Rate for Payer: United Healthcare All Other HMO	$153,580.00
Rate for Payer: United Healthcare HMO Rider	$116,659.00
Rate for Payer: United Healthcare Select/Navigate/Core	$106,879.00

MS-DRG 42.00: EPISTAXIS WITH MCC

Facility

$44,483.90

Service Code	MSDRG 150
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$44,483.90
Rate for Payer: Aetna of CA HMO/PPO	$41,902.78
Rate for Payer: EPIC Health Plan Commercial	$44,483.90
Rate for Payer: EPIC Health Plan Senior	$32,951.04
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,951.04
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,951.04
Rate for Payer: Molina Healthcare of CA Medicare	$44,154.39
Rate for Payer: Multiplan WC	$25,821.50
Rate for Payer: Prime Health Services WC	$25,558.02
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: EPISTAXIS WITHOUT MCC

Facility

$35,620.45

Service Code	MSDRG 151
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,620.45
Rate for Payer: Aetna of CA HMO/PPO	$22,979.53
Rate for Payer: EPIC Health Plan Commercial	$35,620.45
Rate for Payer: EPIC Health Plan Senior	$26,385.52
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,385.52
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,385.52
Rate for Payer: Molina Healthcare of CA Medicare	$35,356.60
Rate for Payer: Multiplan WC	$14,160.54
Rate for Payer: Prime Health Services WC	$14,016.04
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC

Facility

$43,096.60

Service Code	MSDRG 391
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$43,096.60
Rate for Payer: Aetna of CA HMO/PPO	$38,940.90
Rate for Payer: EPIC Health Plan Commercial	$43,096.60
Rate for Payer: EPIC Health Plan Senior	$31,923.41
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$31,923.41
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$31,923.41
Rate for Payer: Molina Healthcare of CA Medicare	$42,777.37
Rate for Payer: Multiplan WC	$23,996.33
Rate for Payer: Prime Health Services WC	$23,751.47
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC

Facility

$35,937.09

Service Code	MSDRG 392
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$35,937.09
Rate for Payer: Aetna of CA HMO/PPO	$23,655.57
Rate for Payer: EPIC Health Plan Commercial	$35,937.09
Rate for Payer: EPIC Health Plan Senior	$26,620.07
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$26,620.07
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$26,620.07
Rate for Payer: Molina Healthcare of CA Medicare	$35,670.89
Rate for Payer: Multiplan WC	$14,577.14
Rate for Payer: Prime Health Services WC	$14,428.39
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT

Facility

$131,174.30

Service Code	MSDRG 933
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$131,174.30
Rate for Payer: Aetna of CA HMO/PPO	$131,174.30
Rate for Payer: EPIC Health Plan Commercial	$86,297.82
Rate for Payer: EPIC Health Plan Senior	$63,924.31
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$63,924.31
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$63,924.31
Rate for Payer: Molina Healthcare of CA Medicare	$85,658.58
Rate for Payer: Multiplan WC	$80,832.78
Rate for Payer: Prime Health Services WC	$80,007.96
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT

Facility

$719,180.40

Service Code	MSDRG 927
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$719,180.40
Rate for Payer: Aetna of CA HMO/PPO	$719,180.40
Rate for Payer: EPIC Health Plan Commercial	$361,714.13
Rate for Payer: EPIC Health Plan Senior	$267,936.39
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$267,936.39
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$267,936.39
Rate for Payer: Molina Healthcare of CA Medicare	$359,034.76
Rate for Payer: Multiplan WC	$443,176.39
Rate for Payer: Prime Health Services WC	$438,654.19
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$74,222.66

Service Code	MSDRG 982
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$74,222.66
Rate for Payer: Aetna of CA HMO/PPO	$74,222.66
Rate for Payer: EPIC Health Plan Commercial	$59,622.22
Rate for Payer: EPIC Health Plan Senior	$44,164.61
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$44,164.61
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$44,164.61
Rate for Payer: Molina Healthcare of CA Medicare	$59,180.58
Rate for Payer: Multiplan WC	$45,737.81
Rate for Payer: Prime Health Services WC	$45,271.09
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$144,119.23

Service Code	MSDRG 981
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$144,119.23
Rate for Payer: Aetna of CA HMO/PPO	$144,119.23
Rate for Payer: EPIC Health Plan Commercial	$92,361.10
Rate for Payer: EPIC Health Plan Senior	$68,415.63
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$68,415.63
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$68,415.63
Rate for Payer: Molina Healthcare of CA Medicare	$91,676.94
Rate for Payer: Multiplan WC	$88,809.77
Rate for Payer: Prime Health Services WC	$87,903.54
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$50,573.15

Service Code	MSDRG 983
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$50,573.15
Rate for Payer: Aetna of CA HMO/PPO	$50,573.15
Rate for Payer: EPIC Health Plan Commercial	$48,545.03
Rate for Payer: EPIC Health Plan Senior	$35,959.28
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,959.28
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,959.28
Rate for Payer: Molina Healthcare of CA Medicare	$48,185.44
Rate for Payer: Multiplan WC	$31,164.40
Rate for Payer: Prime Health Services WC	$30,846.40
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH CC

Facility

$48,848.17

Service Code	MSDRG 038
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$48,848.17
Rate for Payer: Aetna of CA HMO/PPO	$48,848.17
Rate for Payer: EPIC Health Plan Commercial	$47,737.07
Rate for Payer: EPIC Health Plan Senior	$35,360.79
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$35,360.79
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$35,360.79
Rate for Payer: Molina Healthcare of CA Medicare	$47,383.46
Rate for Payer: Multiplan WC	$30,101.43
Rate for Payer: Prime Health Services WC	$29,794.27
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITH MCC

Facility

$100,676.40

Service Code	MSDRG 037
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$100,676.40
Rate for Payer: Aetna of CA HMO/PPO	$100,676.40
Rate for Payer: EPIC Health Plan Commercial	$72,012.90
Rate for Payer: EPIC Health Plan Senior	$53,342.89
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$53,342.89
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$53,342.89
Rate for Payer: Molina Healthcare of CA Medicare	$71,479.47
Rate for Payer: Multiplan WC	$62,039.24
Rate for Payer: Prime Health Services WC	$61,406.19
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$41,019.18

Service Code	MSDRG 039
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$41,019.18
Rate for Payer: Aetna of CA HMO/PPO	$34,505.67
Rate for Payer: EPIC Health Plan Commercial	$41,019.18
Rate for Payer: EPIC Health Plan Senior	$30,384.58
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$30,384.58
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$30,384.58
Rate for Payer: Molina Healthcare of CA Medicare	$40,715.34
Rate for Payer: Multiplan WC	$21,263.23
Rate for Payer: Prime Health Services WC	$21,046.25
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$46,596.83

Service Code	MSDRG 115
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$46,596.83
Rate for Payer: Aetna of CA HMO/PPO	$46,413.80
Rate for Payer: EPIC Health Plan Commercial	$46,596.83
Rate for Payer: EPIC Health Plan Senior	$34,516.17
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$34,516.17
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$34,516.17
Rate for Payer: Molina Healthcare of CA Medicare	$46,251.67
Rate for Payer: Multiplan WC	$28,601.31
Rate for Payer: Prime Health Services WC	$28,309.46
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$180,222.56

Service Code	MSDRG 790
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$180,222.56
Rate for Payer: Aetna of CA HMO/PPO	$180,222.56
Rate for Payer: EPIC Health Plan Commercial	$109,271.54
Rate for Payer: EPIC Health Plan Senior	$80,941.88
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$80,941.88
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$80,941.88
Rate for Payer: Molina Healthcare of CA Medicare	$108,462.12
Rate for Payer: Multiplan WC	$111,057.51
Rate for Payer: Prime Health Services WC	$109,924.27
Rate for Payer: United Healthcare All Other Commercial	$10,809.00
Rate for Payer: United Healthcare All Other HMO	$8,601.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$44,201.34

Service Code	MSDRG 748
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$44,201.34
Rate for Payer: Aetna of CA HMO/PPO	$41,299.49
Rate for Payer: EPIC Health Plan Commercial	$44,201.34
Rate for Payer: EPIC Health Plan Senior	$32,741.73
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$32,741.73
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$32,741.73
Rate for Payer: Molina Healthcare of CA Medicare	$43,873.92
Rate for Payer: Multiplan WC	$25,449.75
Rate for Payer: Prime Health Services WC	$25,190.06
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FEVER AND INFLAMMATORY CONDITIONS

Facility

$37,608.41

Service Code	MSDRG 864
Min. Negotiated Rate	$6,823.00
Max. Negotiated Rate	$37,608.41
Rate for Payer: Aetna of CA HMO/PPO	$27,223.77
Rate for Payer: EPIC Health Plan Commercial	$37,608.41
Rate for Payer: EPIC Health Plan Senior	$27,858.08
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$27,858.08
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$27,858.08
Rate for Payer: Molina Healthcare of CA Medicare	$37,329.83
Rate for Payer: Multiplan WC	$16,775.94
Rate for Payer: Prime Health Services WC	$16,604.76
Rate for Payer: United Healthcare All Other Commercial	$10,506.00
Rate for Payer: United Healthcare All Other HMO	$8,385.00
Rate for Payer: United Healthcare HMO Rider	$7,448.00
Rate for Payer: United Healthcare Select/Navigate/Core	$6,823.00

MS-DRG 42.00: FOOT PROCEDURES WITH CC

Facility

$53,204.58

Service Code	MSDRG 504
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$53,204.58
Rate for Payer: Aetna of CA HMO/PPO	$53,204.58
Rate for Payer: EPIC Health Plan Commercial	$49,777.56
Rate for Payer: EPIC Health Plan Senior	$36,872.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,872.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,872.27
Rate for Payer: Molina Healthcare of CA Medicare	$49,408.84
Rate for Payer: Multiplan WC	$32,785.95
Rate for Payer: Prime Health Services WC	$32,451.40
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FOOT PROCEDURES WITH MCC

Facility

$80,234.33

Service Code	MSDRG 503
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$80,234.33
Rate for Payer: Aetna of CA HMO/PPO	$80,234.33
Rate for Payer: EPIC Health Plan Commercial	$62,438.04
Rate for Payer: EPIC Health Plan Senior	$46,250.40
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$46,250.40
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$46,250.40
Rate for Payer: Molina Healthcare of CA Medicare	$61,975.54
Rate for Payer: Multiplan WC	$49,442.33
Rate for Payer: Prime Health Services WC	$48,937.82
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

MS-DRG 42.00: FOOT PROCEDURES WITHOUT CC/MCC

Facility

$53,204.58

Service Code	MSDRG 505
Min. Negotiated Rate	$7,611.00
Max. Negotiated Rate	$53,204.58
Rate for Payer: Aetna of CA HMO/PPO	$53,204.58
Rate for Payer: EPIC Health Plan Commercial	$49,777.56
Rate for Payer: EPIC Health Plan Senior	$36,872.27
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage	$36,872.27
Rate for Payer: Kaiser Permanente of CA Medicare Advantage	$36,872.27
Rate for Payer: Molina Healthcare of CA Medicare	$49,408.84
Rate for Payer: Multiplan WC	$32,785.95
Rate for Payer: Prime Health Services WC	$32,451.40
Rate for Payer: United Healthcare All Other Commercial	$12,844.00
Rate for Payer: United Healthcare All Other HMO	$10,823.00
Rate for Payer: United Healthcare HMO Rider	$8,307.00
Rate for Payer: United Healthcare Select/Navigate/Core	$7,611.00

Know your out-of-pocket cost for care.

All Charges